The bruises on Clara's upper arms are indicative of something serious that the health visitor, if she, indeed, has been seeing her for two and a half years, should have noted or anticipated. The account given is so scanty that the general information can hardly be gleaned. The other family members should have been asked or given in the account, even if the health visitor does not know the family very well. The barest family statistics could still have been obtained.
Besides Christine, who are the other adults in the family? And how many more children are in it? What is the socioeconomic status of this family? Its culture mix? Christine's educational achievement, her family and work background, her current aspirations and view of her present condition must be obtained. So too the views of the other members be secured.
The bruises on Clara's shoulders would not be visible if the pressure were not hard enough to imprint and create the bruises. It may or may not be the first time to be impressed, the likelihood is greater that this is not the first. The health worker should not have advised Christine to just walk away from Clara if the girl frustrated her or Christine would lose her temper. At Clara's age, leaving her alone can be dangerous and children her age are really difficult to manage. They need much guidance at this age and should not be left alone. What the health worker should have told Christine was to confine her disapproval to Clara's wrong acts out of discipline and not out of revenge or desire to inflict pain.
The head or breadwinner of the family should be sketched out. What does he do? What is his behavior towards his wife and each of the children? What is his family background? Is he aware of the bruises found on Clara's shoulders? It is unlikely that he is completely unaware of the tensions occurring in his own household. He should be asked for his reaction towards his own household. Check out if he is married to Christine or just living with her and the children.
More information should be obtained on Christine's family and work background, her accomplishments in school or work, where she has worked and the things she does at home on a routine basis. If she is responsible for the bruises on Clara's shoulders, she should explain thoroughly why she did the bruising.
Assess the physical environment of the home. That environment is a clear witness of the family's conditions. There need not be costly furniture, appliances and other items. The orderliness and cleanliness of the place will reflect the state of the occupants. It will also reflect the kind of nurturing Christine gives it.
Find out what Christine's personal aspirations are, her chronic frustrations, her joys, her wraths. What does she feel for her husband? What does she feel for each of the kids? Find out how extensive or deep her awareness is of the condition of each member of her family and how much they contribute to one another's fulfillment or frustrate it. Elicit the basis of her impatience. Explore the ground for her insecurity and displacement.
Ask Clara about the bruises. Ask her what she feels about them. Ask her who are kind to her and who are not kind to her. She may or may not supply the information asked, but observe what her non-verbal responses say, because they contain more truthful answers than those she can manage to verbalize. When she is unable to answer, offer guesses. Read between her lines. Ask her to talk about her older siblings, if any. Induce her by asking what her favorite toys are and what she enjoys most doing. With whom does she do these? Discover the other sibling or siblings. Ask the same questions asked of Clara.
Ask the neighbors, too. What do they notice about the family? Surely, they know the other members. What do these neighbors observe? How long have they been living nest or near the family of Christine? What do they perceive from Clara's case? Are they friendly to Christine and her husband? Why or why not?
Additional Information (Acquired)
Christine became a mother long before her own personhood could develop. Worse, the turmoil of pregnancy occurred when she was in the turmoil of adolescence. She will not be able to mother any child without groping for the fulfillment she herself needs first. In the absence of such fulfillment in her present set-up, she will not be able to understand the needs for her children for caring, acceptance and understanding, because she herself does not have these. Much less can she give any guidance, because she lacks it herself. She can only compete with her own children for that sense of security and acceptance in the family, and since she is stronger and more in a position, she will crowd them out for anything that will bring her whatever passes for security and acceptance. At this point, Dennis' presence (and caring) seems to Christine the only (source and meaning of) security to her, and because she perceives that Dennis loves Clara more than her and Anthony, she feels threatened and envious of Clara. Also because Christine has remained very much infantile, she tends to hurt anyone who stands on the way, even if it is her own daughter whom she is supposed to care for and protect. In her stunted emotional development stage, Christine must first secure for herself in full before she can give any bit of her to anyone. Under the situation, that is not very close to happening.
The rejection she experienced from her first boyfriend who deserted her and her own parents who would not help or keep her in her first pregnancy could only leave an indelible wound that needs to be healed before she can care for her own wounds. Promiscuity was her way of winning as much love as she thought she could get, but she realized that it was a wrong way to do it. Her rift from her parents may be the basis for her extreme and unreasonable attachment to Dennis - in search for satisfaction for a father figure. Her break from her helpful sister was a repeat of her break with her mother, whose image Beryl represented.
Christine's headstrong character impedes the emotional development of both children. Her self-seeking stands on the way of her own development and she will not let her sister make sense to her. Christine's too quick rebound with Dennis to cover the gap created by her first boyfriend and the loss of her parents also accounts for the mistake she now faces and which must be born by her children. Because she was only a teen-ager when she gave birth to Anthony, she had no chance to develop herself along. Her identity remains unknown even to her and simply lives an instinctive life, grabbing whatever would seem to further her survival. She needs as much intervention as her two children.
Dennis himself needs to strengthen his self-image for being distant from Anthony and making Anthony's distance greater by getting too close to Clara. It is unhealthy for Clara to be too close to her father and distant or combative towards her mother. Clara's hostility adds to Christine's and this accounts for the physical hostility her mother feels for her. It must be considered that Clara must have, by her antagonistic behavior, provoked the bruises.
Anthony's hostility is passive or turned away from the family which he fears losing. It is the only one he has, although he escapes from it as often as he can. His friends provide him with what he needs to escape intermittently, even if they lead him to criminality. Anthony is a very unhappy boy who feels he cannot do anything about that unhappiness. He might as well get involved in thrills, at least, until his father comes to get him and make his life better.
Anthony's broken ties with his aunt and uncle also prove to be tragic. He should be allowed to resume these, although he feels embarrassed that the sisters had already created a gap between themselves. Anthony could have secured a good object for his father figure from Beryl's husband and more mature mother from his aunt. Anthony needs real and immediate intervention from plunging into criminality and from self-destruction because of inner or un-expressed hostility and sense of rejection.
Social and health workers may recommend an adult educational program and counseling for Christine to supplement her discontinued studies, at the same time, provide her with honest-to-goodness and one-to-one guidance. She should be taught about the stages of emotional-social development, and how she can adjust to these stages, as well as help her children go up and grow up. More than maternal instinct should be cultivated and inculcated in her in encouraging her to work for the development of her…